FACTS OF 2019102
* SOURCE: HOSPITAL AUTHORITY, HKSAR
* SOURCE: HOSPITAL AUTHORITY, HKSAR
Signs and symptoms
The pancreas is an organ that sits behind the stomach. In adults it is about 15 cm long and less than 5 cm wide and can be divided into three parts: the head, the body, and the tail.103 The pancreas has two main functions - to make pancreatic enzymes that help digest food, and to produce insulin and glucagon, that help control blood sugar levels.104
Pancreatic cancer is sometimes called a “silent cancer” because there are generally no symptoms in the early stages.105 When people do have symptoms, they are often similar to the symptoms of other medical conditions, such as a stomach ulcer,105 and can often be overlooked by both patients and medical professionals.
Signs and symptoms of pancreatic cancer may include: 105
Causes and risk factors
The exact cause of pancreatic cancer in an individual is still being researched upon. However, many risk factors associated with pancreatic cancer have been identified. Some of them include:106
BRCA gene mutations and pancreatic cancer
Mutations in the BRCA1 and BRCA2 genes increase a person’s risk for several cancers, including pancreatic cancer.107
For carriers of mutations in BRCA2, the lifetime risk of developing pancreatic cancer is estimated to be 5-10%; mutations in BRCA1 are estimated to lead to a 2-4 times increased risk. 107
Many guidelines now recommend genetic testing for any person diagnosed with pancreatic cancer, regardless of their family history of cancer or age at diagnosis.107, 108
The identification of an inherited gene mutation is being used to help direct cancer treatment and screening. Genetic counseling is essential before and after genetic testing.
- 5-10% LIFETIME RISK
of BRCA2 developing pancreatic cancer107 - 2-4 TIMES RISK
of BRCA1 lead to develop pancreatic cancer107
Diagnosis
Tests for pancreatic cancer may include: 109
TYPES OF PANCREATIC CANCER
DIAGNOSES & TREATMENT
TREATMENT OPTIONS
Different types of treatment are available for patients with pancreatic cancer. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Patients should discuss with their doctor to decide on the most appropriate treatment for them.
Surgery for pancreatic cancer includes removing all or part of the pancreas, depending on the location and size of the tumor in the pancreas. Only about 20% of pancreatic cancer patients are able to have surgery because most pancreatic cancers are found after the disease has already spread.113
One of the following types of surgery may be used to remove the tumor:
Surgery
Surgery for pancreatic cancer includes removing all or part of the pancreas, depending on the location and size of the tumor in the pancreas. Only about 20% of pancreatic cancer patients are able to have surgery because most pancreatic cancers are found after the disease has already spread.113
One of the following types of surgery may be used to remove the tumor:
Radiotherapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. The most common type of radiotherapy is called external beam radiotherapy, which is radiation given from a machine outside the body.113 Other types of radiotherapy may also be offered. Patients should talk with their doctor about the most appropriate treatment for them.
Radiotherapy
Radiotherapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. The most common type of radiotherapy is called external beam radiotherapy, which is radiation given from a machine outside the body.113 Other types of radiotherapy may also be offered. Patients should talk with their doctor about the most appropriate treatment for them.
Chemotherapy uses drugs to kill cancer cells or stop them from growing, dividing, and making more cells.113 It can be taken by mouth or injected into a vein or muscle. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time.
Chemotherapy is often part of the treatment for pancreatic cancer and may be used:114
There are several standard chemotherapy drugs used for pancreatic cancer. Patients should discuss with their doctor to decide the most appropriate treatment for them.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells or stop them from growing, dividing, and making more cells.113 It can be taken by mouth or injected into a vein or muscle. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time.
Chemotherapy is often part of the treatment for pancreatic cancer and may be used:114
There are several standard chemotherapy drugs used for pancreatic cancer. Patients should discuss with their doctor to decide the most appropriate treatment for them.
Targeted therapy is a type of drug treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.113 This type of therapy blocks the growth and spread of cancer cells and limits damage to healthy cells.
Some targeted therapies only work in people whose cancer cells have certain genetic mutations, such as BRCA1 and BRCA2 mutations. To find the most effective treatment, doctors may advise their pancreatic cancer patients to take tests to identify the genes, proteins, and other factors in their tumor cells. This helps doctors better match each patient with the most effective treatment whenever possible.113
Targeted therapy
Targeted therapy is a type of drug treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.113 This type of therapy blocks the growth and spread of cancer cells and limits damage to healthy cells.
Some targeted therapies only work in people whose cancer cells have certain genetic mutations, such as BRCA1 and BRCA2 mutations. To find the most effective treatment, doctors may advise their pancreatic cancer patients to take tests to identify the genes, proteins, and other factors in their tumor cells. This helps doctors better match each patient with the most effective treatment whenever possible.113
Immunotherapy is a type of treatment designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.113
Certain types of immunotherapy can be used to treat pancreatic cancer. Patients should talk with their doctor about the most appropriate immunotherapy for them.
Immunotherapy
Immunotherapy is a type of treatment designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.113
Certain types of immunotherapy can be used to treat pancreatic cancer. Patients should talk with their doctor about the most appropriate immunotherapy for them.
General recommendations may include:
- Maintaining good nutrition:115,116 Healthy food can help a person cope with treatment and side effects. Balanced diet with adequate protein can help people with pancreatic cancer maintaining a healthy body weight. In addition, eating small, frequent meals can help reduce fatigue. Depending on the type and location of pancreatic cancer, some individuals need to avoid excess fat intake due to pancreatic enzyme insufficiency. And the use of enzyme supplements can often help with fat digestion. Patients are encouraged to work with a dietitian to determine an individualized diet that works best for their digestive system.
- Staying active:116 Physical activities can reduce tiredness, improve circulation, and lift mood. The right exercise for a pancreatic cancer patient depends on many factors, such as what treatment is being used, how the patient feels, and what is his or her general health condition. Patients should talk with their doctor to help them develop an exercise plan.
- Complementary therapies:116 Complementary therapies are designed to be used alongside conventional medical treatments. Therapies such as massage and relaxation can increase a person’s sense of control, decrease stress and anxiety, and improve mood. Patients should talk with their doctor about any therapies they are using or thinking about trying, as some may not be safe, or evidence based.
Main follow-up care may include:
- Watching for cancer recurrence:117 Sometimes pancreatic cancer does come back after treatment. During follow-up care, a doctor will ask specific questions about the patient’s health. Blood tests or imaging tests may sometimes be recommended as part of regular follow-up care, but testing recommendations depend on several factors, such as the type and stage of cancer first diagnosed, and the types of treatment given.
- Managing long-term and late side effects:117 Some patients may experience side effects that linger beyond the treatment period, which are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes. Patients should talk with their doctor about their risk of developing late effects.
(Note: Hong Kong Academy of Medicine would like to remind the public, any genetic test without appropriate advice, counseling and data analysis may lead to additional medical risk and inaccurate test results, and the lack of professional interpretation and advice may also cause unnecessary anxiety or a false sense of safety.)120
FAQ
FOR CAREGIVERS
If you are a caregiver to take care of a pancreatic cancer patient, you are playing an important role! You are the one taking care of the patient’s daily and medical care during and after the treatment. But do not forget to look after yourself, as you must be strong enough to go through this journey with the patient. The following suggestions may help you as a caregiver:
Understand pancreatic cancer
The process of pancreatic cancer diagnosis and treatment is a difficult journey for patients, and they need understanding, care, and empathy from people around them. Gathering the latest information on pancreatic cancer can help you understand the physical change and conditions of the patient, thus facilitate better communication.
Try to de-stress
As a caregiver, you are under huge stress. Learn how to de-stress and to deal with your own emotions, such as anxiety, distress, and negative feelings.
Seek help
Caregivers are just ordinary people - we only have limited energy and capability. When caregivers find it difficult to deal with the caregiving work, they should be more open and seek help from other relatives, healthcare professionals, or community resources. Remember that you are not alone as a caregiver.
Talk to others
It is reasonable to have feelings and emotions when seeing our beloved one suffers, or when you have to take over the responsibility as a caregiver. Talk with your friends, family members, healthcare professionals, or patient's groups, sharing your feelings and avoiding the accumulation of negative emotions.
Be considerate
If the patient is your partner, you should understand that your sex life may be affected when your partner is undergoing chemotherapy, after the surgery, or when the disease is at advanced stages. Be considerate and treasure the time together.